Greater Peoria Metro Area, IL

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How Healthcare Consumption Works 3 Scenarios

  June 06, 2019

By Steven A. Buttice, Living By Your Design

He was fairly young at age 32 and had not a trouble in the world. He never saw the reason to have a doctor and when he applied for his insurance plan, he only looked at the least expensive plans. Then there was a day in January when his vision wasn’t quite right. He stopped into a quick vision-testing store and learned he had an eye problem that might require surgery and needed to see an ophthalmologist.

The insurance plan he enrolled in is an HMO type of plan requiring him to get a referral from his Primary Care Doctor (PCP). Well, that was a problem as he never established himself with a PCP. So, he called the PCP listed on his insurance card and found that the earliest they would get him in as a new patient was nearly four weeks away. He also contacted an ophthalmologist and was told he needed a referral prior to seeing the eye surgeon. So, he saw his PCP and was referred to the ophthalmologist. Again, he had to wait for an appointment time. Nearly six weeks went by before he had his right eye retina reattached. If this gentleman would have had an established PCP, this process could have been cut to a several day process. He did not have the wrong plan, he just didn’t understand his current plan and how to use his PCP efficiently.

Perhaps the best way to look at your PCP is that he/she is the gatekeeper. Your PCP should be aware of all of the doctors you see and the meds you take. One step further: the medical system seems to work best when your PCP is guiding you to specialists, accessing their reports and any medications they want prescribed. In this way, your PCP will most likely catch any prescription interactions or adverse effects with other meds you are taking.

With the above being said, there is currently a movement in healthcare to an old-fashioned solution used in the 1930s and 40s. During this time period, it was important to keep factories and assembly lines operating. People commonly did not go to the doctor unless they were very ill. So, to keep assembly line open, the companies brought the doctor to the worker in a “worksite clinic.” This process caught minor problems like illness earlier, resulting in quicker recovery with less exposure to others, thus less lost time from work.

The worksite clinic would refer workers if the condition was more serious. Even then, the clinic would make the referral and access the specialists’ records. This concept has been catching on in the past few years with larger corporations. The concept is to catch illness early and treat for a quicker recovery. Therefore, there is less exposure to other workers. The other byproduct of this approach is to lower employee health plan premium costs by catching conditions early when they are most treatable.

Another healthcare model is the use of virtual care. This is where a patient could Facetime their physician, show an image of an affected area if helpful, and begin the treatment or referral process. The insurance companies have embraced this model, as have many consumers. It cuts costs for the insurance companies while providing convenience for the patient and lowers the risk of exposure to the illness to others.

There are several models of healthcare. It comes down to what services are available for you and what works best. However, when it comes to the insurance companies and care, it is most important to establish yourself with a PCP.
As always, feel free to contact our office if you have questions.

For more information, contact Living By Your Design, Inc., focusing on the issues of older Americans:legal, financial, free guidance for residential placement and healthcare issues. Call: 309-285-8088. Web: Location: 809 W. Detweiller Dr., Peoria.
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June 06, 2019


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